Ultrastructural evidence for persistent gold in the bone marrow of a patient with aplastic anemia

✍ Scribed by Bruce D. Cheson; Dr. Daniel O. Clegg; Farhad Moatamed

• Publisher: John Wiley and Sons
• Year: 1986
• Tongue: English
• Weight: 542 KB
• Volume: 29
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780290117

✦ Synopsis

Patients receiving gold therapy for rheumatoid arthritis or other inflammatory disorders may develop aplastic anemia, thrombocytopenia, agranulocytosis, proteinuria, glomerulopathy , dermatitis, and stomatitis (1-3). We describe a patient with chronic juvenile rheumatoid arthritis who developed aplastic anemia subsequent to gold therapy. Using electron microscopy and energy dispersive x-ray analysis (EDXA), we demonstrated the persistence of gold in her bone marrow macrophages months after cessation of gold therapy .

Case report. A 29-year-old white female first developed symptoms of nondeforming arthritis at age 5. Exacerbations occurred approximately every 4 years and involved the first metacarpophalangeal joints, elbows, and knees. She had been treated with aspirin, indomethacin, oxyphenbutazone, ibuprofen, fenoprofen, and sulindac. In January 1980, all other medications were discontinued, and a course of aurothioglucose (Solganal) was initiated at a dosage of 50 mg intramuscularly, weekly, until June 4, 1980, when the interval was changed to every other week.

In October, her hemoglobin level was 13.4 gm/dl, her hematocrit value was 39.3%, and her white